Morie Abibu, a 56-year-old father of three, lies on a hospital bed in the humid Sierra Leonean heat. He is paralyzed from the neck down. After months of immobility, his soft muscles sag and pool on the bed, barely hanging onto bone. A mass is growing at the base of his skull, pressing against his spinal cord. And as it grows, it obstructs the nerves that control his breathing. He is slowly suffocating to death.
Abibu needs neurosurgery to remove the deadly pressure.
"Without it, he will have a devastating end of life," says Dr. Marco Lee, past president of the Western Neurosurgical Society. "When your breathing starts to go, it's like this constant feeling of drowning."
That would have been Abibu's fate before this year, but today, he is at Connaught Hospital under the care of Dr. Alieu Kamara, the first and only neurosurgeon in Sierra Leone. After starting his practice at the beginning of January 2025, Kamara carries the neurosurgical disease burden — traumatic injuries, spinal paralyses, seizures, brain tumors — of an entire country of eight million people.
"Before Dr. Kamara, there was no hope," said Dr. Kehinde Oluwadiya, acting chief medical director of the University of Sierra Leone Teaching Hospital Complex. "If you are lucky and rich, you will go to another country and be treated. But if you are not, it's either you die or you live with a lot of disability."
Five months after Kamara's practice began, April Sabangan, CEO of Mission Brain — a California-based nonprofit advancing global neurosurgical care — along with two surgeons from Stanford, Dr. Seunggu Han and Dr. Silvia Vaca, visited to support the fledgling service.
Connaught Hospital's surgical ward consists of two operating rooms shared by all surgical specialties, three rotating anesthesiologists and a team of nursing staff. Kamara is the only doctor in the new neurosurgical department.
There, they met Morie Abibu.
An incision is made, the power goes out
Before Abibu's surgery, the operating room must be set up. Bolsters to support him are improvised using rolled-up surgical gowns wrapped in masking tape. Someone climbs a ten-foot ladder to replace the burned-out ceiling bulbs. Another nurse swipes at the flies that had snuck in before the surgery using an electric-powered swatter — to prevent any from landing on the sterile field.
Kamara makes the first incision. Abibu's brown, leathery skin splits easily. Vaca hands Kamara forceps that deliver a controlled electric current. He begins burning through muscle and fat. Han holds the vacuum, sucking out blood and fluid. It's a delicate dance. Burn, suck, cut.
An hour and a half later, Kamara tweezes out a chunk of rough, spongy bone. It is mottled — dark from the tumor and yellow from abnormal growth — like a piece of molding cheese. It clangs when dropped into the metal tin. Beneath the bone, the pale, smooth tube of spinal cord is exposed. It looks like a piece of white rubber, floating atop a river of blood. The spinal cord pulses with Abibu's heartbeat — a good sign.
Suddenly, the lights go out. The room is plunged into darkness. Power outages are common during the heavy storms of Sierra Leone's rainy season. The small battery-powered surgical headlights Vaca and Han brought with them are the only sources illuminating Abibu's wound — a mess of blood and bone. The operation can't stop. Every minute Abibu is open on the operating table increases the risk of surgical complications.
Vaca leans down, bringing her surgical headlight closer to the wound to help Kamara see. He continues controlling the bleeding and smoothing the edges of the remaining bone. One wrong move and the spinal cord could be severed. Thankfully, a minute later, the emergency generator kicks in, and the lights flicker back to life.
The power goes out twice more during the operation.
Three hours later, as Kamara finishes running a line of fourteen staples over the incision, everyone releases a collective breath.
They have just completed the first-ever spine surgery in the country.
It started with a broken arm
Alieu Kamara, 43, was born in a small village in eastern Sierra Leone. His path to medicine was marred by conflict. The 11-year civil war spanned his childhood. His family often had to hide in the bushes in the countryside — sometimes for days at a time — to escape rebel attacks.
During a soccer game in secondary school, Kamara accidentally fouled his friend, who fell and broke his arm. Seeing his friend's pain with no way to help, Kamara resolved to become a doctor. After studying hard to pass his medical entrance exams, Kamara didn't have the means to pay tuition. He spent two years working in a factory, manufacturing plastic bowls and bags. Even still, it wasn't enough.
Serendipitously, he heard of a scholarship to study medicine in Jilin, China. He trained there for 12 years, receiving both an MD and a Ph.D. in orthopedic surgery before returning to Sierra Leone in 2020.
After coming back home, Kamara would operate on patients with broken bones and fractures at Connaught Hospital. However, because there was no neurosurgical ward, patients who came in with head and spine injuries could only be placed under orthopedic care. Many of their injuries had been caused by falls or blunt trauma — cases requiring neurosurgical skills he lacked. It was an imperfect system. Either Kamara could turn them away or try to stabilize them. But that wasn't always possible.
"We used to lose a lot of patients due to head injuries, spinal cord injuries, spine fractures and the like," Kamara said. "There was nothing we could do for them."
It was clear: The country needed a neurosurgeon. And he wanted to pursue training to be the first.
It takes a network
Giving Abibu a chance at life again took more than a single surgeon. It required an expansive grassroots network.
In 2021, Fatu Conteh — a neurosurgery resident in California who fled Sierra Leone during the civil war — visited her home country. On her third day, her grandmother had a stroke. She frantically drove her grandmother to Connaught Hospital. Without access to timely treatment, she became paralyzed and wheelchair-bound. In disbelief and determined never to let this happen to anyone else, Conteh connected with Dr. Sonia Spencer, the chairperson of the hospital complex.
"Then the dream was born to bring neurosurgery to Sierra Leone," Spencer said. "I told Fatu, 'Go find us some partners.'"
Conteh cold-emailed neurosurgeons involved in global health, scheduled calls with nonprofits and chased tentative commitments and unfulfilled promises. Progress was slow until she met Dr. Kee Park in 2022 over Zoom. As co-chair of the Global Neurosurgery Committee from the World Federation of Neurosurgical Societies, Park had connections internationally. His excitement for the project was infectious. He was constantly creating email chains and setting up meetings between Conteh and his colleagues around the globe.
The most pivotal introduction was with April Sabangan of Mission Brain. Known affectionately as "Green Light April," she draws on her UCSF nursing background to support surgeons in underserved regions and expand neurosurgery access worldwide. Since its inception in 2011, Mission Brain has expanded to over 100 chapters spanning 27 countries.
After traveling to Sierra Leone in 2023 to meet with Conteh, Kamara, the ministry of health and the vice president, Sabangan was committed to starting a sustainable partnership. It would be the charity's biggest capacity-building project yet: to arrange Kamara's neurosurgical training and provide the necessary infrastructure such as surgical supplies and nursing staff.
Funding for the project — an ongoing and expansive effort — was cobbled from personal donations and support from Mission Brain's foundation. The group also covered Kamara's living expenses and funded virtual nursing classes run by Global Neuro, a Swiss-based neurotrauma education provider. Dr. Abdessamad El Ouahabi, a neurosurgeon based in Morocco and Park's co-chair of the Global Neurosurgery Committee, offered to train Kamara for free in an 18-month neurotrauma fellowship. At her wedding, Conteh asked for donations to the project in lieu of gifts.
Park's extensive network donated spine and neurosurgical instrument sets, which were tucked into physician's carry-on suitcases to get from Pakistan to Geneva, then loaded on Mercy Ships, a hospital run on an ocean liner. Mission Brain supplemented these efforts by sending shipments of medical supplies and consumable equipment.
These collaborations paved the way for incremental progress as they built a neurosurgery program from the ground up.
The toes give a sign
Six hours later, Abibu is back in the wards. His wife sits on the ground, squeezing his legs. After scavenging through hospital stockrooms, they managed to find a plastic brace three sizes too big. It's not perfect, but it's the best they can come up with to protect the incision area and stabilize his neck.
"How are you feeling?" Kamara asks.
Abibu opens his bleary eyes and nods his head 'yes' to show he's okay. Kamara stands around him, examining his limbs.
"Can you try and move your toes?" Kamara asks.
There's a flicker of movement. Abibu's left foot flexes, his toes moving upward. He repeats it. It's a delicate motion, almost like the beat of a butterfly wing.
"Thank you Jesus, thank you Jesus, thank you Jesus," his wife whispers in a breathless prayer. She clasps her hands in front of her chest.
"For a patient paralyzed for months to move their toes just six hours after surgery is almost unheard of. It's a miracle," says Vaca, "I'm trying not to cry."
Facing challenges, practicing kindness
Like most neurosurgery patients, Abibu's recovery has been long and arduous. But he has faced broader logistical challenges.
With Connaught Hospital's limited supply of IV fluids, bandages and gauze, it's possible that Abibu would have survived a steel scalpel only to succumb to invisible microbes. Delays in changing dressings or disinfecting wounds could have been fatal.
Also, tracking proper wound healing is not easy. Connaught Hospital's imaging capabilities are limited. Abibu's only CT scan was done at a faraway military hospital. If complications were to occur, there's no easy way to visualize what's happening beneath the skin without transporting Abibu back to that hospital on bumpy roads.
Many patients also lack the money to pay for their operations. In Sierra Leone, hospitals will not begin treatment without advance payment. Abibu's family had to borrow $300, or 6750 Leones, from a neighbor — half of a local family's average yearly income — to cover the cost.
But Kamara and Connaught Hospital are committed to addressing these challenges.
The government is working to develop more sustainable systems, such as a dedicated neurosurgery ward and has purchased a CT scanner for Connaught Hospital. With Mission Brain's help, already, 24 nurses have been trained and received certificates in neurotrauma patient management. The teaching hospital complex is also establishing a Sababu fund for indigent patients — that's the local Creole word for "kindness."
"I see this as a litmus test for what is possible in the health sector. There's a lot of pessimism in our system," said Dr. Mustapha Kabba, the deputy chief medical officer of the Ministry of Health. Given the complexity of neurosurgery, its success in Sierra Leone can have a ripple effect on the country. Kamara not only treats patients but also plans to establish a teaching service. He already has medical students and residents rotating on his surgeries, potentially inspiring a new generation of professionals to drive meaningful change. "It shows them that it can be done," he said.
Kamara is determined, but he knows the work is just beginning. For him, it all returns to the day-to-day care of his patients. He gives all of them his phone number and picks up their calls at any time of day. "I work around the clock. I work 7 days a week. I have to follow up on patients," Kamara said.
"The ultimate goal for neurosurgery in Sierra Leone is for us to be self-sufficient."
Sophia Li is a medical student at Harvard Medical School. She serves as a nonfiction editor for Intima, a journal of narrative medicine.
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